Pain and lumbopelvic impairments in women with endometriosis

Abstract

Introducción: Endometriosis is a heterogeneous disease characterized by the proliferation of endometrial-like tissue outside the uterus cavity (also called endometriotic lesions), with extensive variation in anatomical and clinical presentation, and symptoms do not always correspond to the disease burden. Metodología This cross-sectional study included 66 women (41 women with endometriosis and 25 healthy women). Pain and related catastrophizing thoughts were assessed through a numeric rating scale, pressure pain thresholds (PPTs), the slump test, and the Pain Catastrophizing Scale. Lumbopelvic muscles were evaluated through ultrasound imaging, flexor/extensor resistance tests, and the lumbopelvic stability test. Sample size was calculated with Epidat 3.4 (Xunta de Galicia, Spain) and PPTs served as primary outcome. Hence, to detect a minimal difference of 20% in the PPTs between groups with an a-level of 0.05, a desired power of 80%. Resultados No differences were observed in the baseline characteristics of the 66 participants except for employment status and the use of hormonal contraceptives, with higher prevalence of unemployment and use of oral contraceptives in the endometriosis group (P values <.001). Two-thirds of affected women had undergone laparoscopy (80.5%) or laparotomy (19.5%) for endometriosis-related pain relief (in most cases) or endometriotic lesion removal >1 year before evaluation. A total of 26 (63.4%) out of 41 of them were diagnosed with stage IV endometriosis. All women with endometriosis declared to be fully adhered to the medication (oral contraceptives and/or anti-inflammatories in all cases). Women with endometriosis showed increased self-reported intensity of current pelvic pain (CuPP), reduced local PPTs (42.8–64.7% in the affected area, P-value <.001) and higher prevalence of lumbar nerve root impingement/irritation pain and catastrophizing thoughts (P-value <.002). Moreover, affected women showed decreased thickness of transversus abdominis, and lower lumbopelvic stability (P-values <.030). Discusión - Conclusión: Taken together, the findings of this study have direct clinical implications. Endometriosis patients, that are currently treated with surgical and medical treatments (in absence of evidence for rehabilitative therapies), develop lumbopelvic impairments that may determine or aggravate endometriosis burden of symptoms, leading to increased economic costs for health systems. Therefore, the presence of pain sensitization signs and lumbopelvic impairments, more pronounced in patients with stage IV endometriosis and moderate/severe CuPP, warrants the development of rehabilitation interventions targeting pain and lumbopelvic impairments in women with endometriosis.